Errors in the administration of medications to residents of long-term care facilities (LTCFs) threaten resident safety and add significant unnecessary costs to the healthcare system. Use of unit dose medications that require LTCF staff to manually sort and assemble specific patient medications ~4 times per day can result in error rates as high as 42%, with 7% of total errors having significant potential for harm. Just preparing medications for administration consumes an estimated 6-8 person hours/day in a typical 100 resident LTCF, or an estimated 16,000 full time equivalents in all US LTCFs, reducing staff time available for other functions. Another unnecessary cost, estimated at $5 billion in US nursing homes alone, arises from medications that are wasted due to prescription changes and patient turnover. New regulations from the Centers for Medicare and Medicaid Services, effective 1 January 2013, target reduced medication waste by requiring short cycle fills (d14 days) instead of the traditional 30 day bingo cards. However, even if this has the desired result of reducing prescription drug waste, industry sources predict that use of shorter cycle bingo cards may increase LTCF staff time and possibly errors associated with additional manual sorting of more unit dose packages. Proposed Solution. Artaic's novel PillStreamTM system incorporates proven advanced agile manufacturing technology, utilized in our successful TileJet robot developed for high speed low-cost mosaic just-in-time manufacturing. PillStream is designed for high accuracy, high throughput production of Custom Multi-medication Packages (CMPTM) that will enable Central-Fill pharmacies to provide their LTCF customers with short cycle dispensing at reduced cost and with closed-loop capability enabling return of unused medications. In SBIR Phase I we created a PillStream prototype that exceeded our primary success criterion of e99.9% placement accuracy for surrogate pills and gelatin capsules while exceeding our target fill rate (100 blisters/min) by 50%. Specific Aims. In this 24-month Phase II SBIR we propose to: 1) build and test a larger fully functional Pill- Stream prototype able to dispense up to 48 fast mover pills/capsules directly from wholesale medication bottles; 2) modify the onboard PS48 software to enable integration with pharmacy management software; and 3) beta test the PS48 in up to 2 Central-Fill pharmacies, using it to fill daily patient-specifc CMPs containing fast mover medications in order to compare accuracy and cost to existing methods. Success in meeting our target SBIR Phase II engineering specifications for accuracy (e99.99%) and throughput (e100 blisters/min and e10 daily CMPs/minute) in a real Central-Fill pharmacy setting should enable Artaic to raise Phase III funds for commercial production of PS48 and larger PS100 and PS200 units.